Introduction
Cervical cancer is a type of cancer that is characteristic of affecting cells in the human cervix. I begins on surface of the cervix. Usually, these cells become pre-malignant/ pre-cancerous. Cervical cancer cells are different from normal cervical cells.
For cervical cancer cells, there is;
- Difference in cell shape and size- cellular pleormorphism
- Loss of structure
- More fluid inside the cell
- Nuclear hyperchromasia- darkened nucleus
- Nuclear pleomorphism
Generally, cervical cancers grow slowly. The extent of spread and its size determine its seriousness.
Types
Two major kinds of cancer of the cervix are;
- Adenocarcinomas
- Squamous cell carcinomas
The two forms can also co-exist.
Epidemiology & Statistics
- Cervical cancer is one of the most common types of cancer globally, alongside breast cancer and others.
- This type of cancer mostly affects women under 45 years old.
- In the United States of America, more than 10,000 individuals are diagnosed with cervical cancer every year.
- In the year 2020, it is estimated that there were 604,000 new cervical cancer cases. Over 300,000 deaths were reported in the same year.
- In the United States, almost 37,000 cancer-related cases are due to HPV.
- These are mostly women and persons assigned female at birth, aged between 35-44 years old.
- Of the 2 types of cervical cancer listed earlier, squamous cell carcinomas account for 80-90% while adenocarcinomas are represented as 10-20%.
Risks & Causes
Risk factors for cervical cancer include;
- Smoking tobacco
- HIV infection- HPV type 16 and type 18
- Other STIs such as gonorrhea, chlamydia and syphilis.
- Weak immune system
- Family history
- A drug for prevention of miscarriage called diethylstilbesterol(DES), increased chances of cervical cancer development in women born to mothers who had taken it. It was administered between 1938-1971.
- Sexual history of many partners, especially if these were unsafe sexual practices.
- HPV infection. HPV type 16 and type 18 are responsible for cervical cancer.
- Screening history. Failure of screening leads to missed detection of precancerous cells.
Causes;
Mostly HPV infections- Human Papilloma Virus spreads through sexual contact.
Signs & Symptoms
- Pelvic pain
- Pain during sexual intercourse.
- Heavier and longer menses.
- Per vaginal bleeding after sex.
- Heavy and smelly watery, bloody vaginal discharges
- Post-menopausal vaginal bleeding
Stages
It is divided into 4 main stages; I, II, III, IV.
- Stage I: The cancer is still located in the cervix and has not yet spread.
- Stage II: It has spread beyond cervix and uterus, but not pelvic wall.
- Stage III: It spreads to pelvic wall, lower part of vagina, surrounding lymph nodes and ureters
- Stage IV: Cancer spreads to bladder and rectum. It also metastasizes to distant organs such as lungs.
Tests for Diagnosis
- Colposcopy with biopsy
- Cone biopsy
- Punch biopsy
- LEEP- Loop electrosurgical excision procedure
- Endocervical curettage
After diagnosis/ confirmation that there is cervical cancer, your doctor will order the following tests to check for extent of spread;
- Magnetic resonance imaging (MRI)
- X-ray test of bladder, lungs
- Blood tests
- Urine tests
- Liver function tests
- Kidney function tests
Treatment & Management
Surgery;
- Laser surgery
- Pelvic exenteration
- Cryosurgery
- Trachelectomy
- Hysterectomy
Chemotherapy;
- Radiation chemotherapy
- Brachytherapy. The radiation is placed in or just around the cancer.
- External beam radiation therapy(EBRT). A device located outside the body targets a radiation at a cancer.
Targeted therapy
Immunotherapy
Complications
- Increased chance of infertility
- Per vaginal bleeding
- Risk of blood clot formation
- Kidney failure
- Bladder changes such as difficulty urinating
- Pain due to metastasis
- Bowel changes such as constipation
Prevention Ways
- Pap smear testing
- Practicing safe sex
- Eligible individuals should get vaccinated against HPV
- Avoid smoking tobacco and related products
- Limit the number of sexual partners
- Use condoms properly during sexual intercourse. Other barrier methods can also be employed.
- Create awareness through campaigns.